Legal Source of Funds Declaration

Legal Source of Funds Declaration

This Legal Source of Funds Declaration (the Declaration) is made as of Date: between Declarant Name: , Declarant Address: ; and Recipient Name: , Recipient Address: .

Recitals

WHEREAS, the Declarant intends to transfer, invest, lend, or otherwise deliver funds to the Recipient in connection with the transaction described as: (the Transaction); and

WHEREAS, the Recipient requires a written declaration of the legal source of the funds and supporting documentation to meet its obligations under applicable laws, regulations and internal compliance procedures; and

WHEREAS, the Declarant is willing to declare and warrant the origin and legality of such funds to induce the Recipient to accept the funds and proceed with the Transaction.

NOW, THEREFORE, in consideration of the Recipient's acceptance of the funds and the mutual covenants contained herein, the parties agree as follows:

1. Definitions

In this Declaration, unless the context otherwise requires: "Funds" means the money, instruments or other assets to be provided by the Declarant in connection with the Transaction; "Supporting Documentation" means originals or certified true copies of documents evidencing the lawful source of Funds.

2. Declaration of Source of Funds

The Declarant hereby declares, represents and warrants that the total amount of Funds to be provided in respect of the Transaction is: Amount: Currency: . Date funds available: .

The Declarant identifies the legal source(s) of the Funds by selecting all applicable categories below and providing the requested details:

3. Supporting Documentation

The Declarant shall provide, contemporaneously with this Declaration, copies of Supporting Documentation sufficient to substantiate the declared source(s). Typical documents include pay statements, tax returns, sale agreements, bank statements, loan agreements, probate documents, and certified identification.

4. Use of Funds

The Declarant certifies that the Funds are intended to be used for: . The Declarant shall not use the Funds for unlawful purposes or to facilitate evasion of law or regulation.

5. Representations and Warranties of Declarant

The Declarant represents and warrants that:

1. All information and documents provided in connection with this Declaration are true, complete, accurate and not misleading in any material respect.
2. The Funds originate from lawful sources and do not constitute proceeds of criminal conduct, money laundering, terrorism financing, tax evasion, sanctions evasion or any other unlawful activity.
3. The Declarant is not subject to sanctions, enforcement orders, or material regulatory restrictions that would prohibit acceptance of the Funds by the Recipient.
4. The Declarant is current with tax obligations relating to the Funds and has disclosed any material tax positions affecting the origin of the Funds.

6. Consent to Verification

The Declarant expressly consents to the Recipient and its agents obtaining, verifying and retaining records relating to the Declarant and the source of the Funds from third parties, including financial institutions and governmental authorities, for the purposes of compliance with applicable law and internal compliance policies. Consent to contact: .

7. Indemnity and Liability

The Declarant shall indemnify, defend and hold harmless the Recipient, its affiliates and their respective officers, directors and agents from and against any claims, losses, liabilities, fines or expenses (including reasonable attorneys' fees) arising out of a breach of any representation, warranty or covenant in this Declaration or from any misstatement, omission or invalid documentation furnished by the Declarant.

8. Remedies

If the Declarant breaches this Declaration or if the Recipient reasonably suspects that the Funds are unlawful, the Recipient may suspend acceptance of the Funds, return the Funds to the source of remittance, report to competent authorities or take any other action required by law or prudent compliance practice.

9. Confidentiality

Except as required by law, regulation, governmental request or internal compliance procedures, the Recipient shall treat information provided under this Declaration as confidential and use it solely for purposes related to the Transaction and legal compliance.

10. Notices

All notices under this Declaration shall be in writing and delivered to the addresses set forth in the opening paragraph, or to such other address as a party may designate by written notice to the other party.

11. Governing Law; Entire Agreement; Severability

Governing Law: This Declaration shall be governed by and construed in accordance with the laws of the jurisdiction specified by the parties: .

Entire Agreement: This Declaration constitutes the entire agreement between the parties relating to the subject matter hereof and supersedes all prior agreements, understandings and communications, whether written or oral, with respect to such subject matter.

Severability: If any provision of this Declaration is held invalid or unenforceable in any respect, the validity and enforceability of the remaining provisions shall not be affected, and the parties shall negotiate in good faith to replace the invalid or unenforceable provision with a valid provision that best accomplishes the parties' original intent.

12. Amendments; Waiver; Counterparts

Any amendment to this Declaration must be in writing and signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party waiving compliance. This Declaration may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

Certification and Warning

The Declarant certifies under penalty of perjury under the laws of the governing jurisdiction that the foregoing statements are true, correct and complete to the best of the Declarant's knowledge. The Declarant acknowledges that making a false declaration may result in civil or criminal penalties.

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